Prognostic Impact of Surgical Intervention After Lenvatinib Treatment for Advanced Hepatocellular Carcinoma
Prognostic Impact of Surgical Intervention After Lenvatinib Treatment for Advanced Hepatocellular Carcinoma
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DOI：
10.1245/s10434-021-09974-0
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发表时间：
2021-04-26
影响因子：
3.7
通讯作者：
Hashimoto, Masaji
中科院分区：
文献类型：
--
作者：
Shindoh, Junichi;Kawamura, Yusuke;Hashimoto, Masaji
背景随着新的分子靶向药物的引入，越来越多的晚期肝细胞癌（HCC）患者受益于挽救性干预;然而，实际的转换手术率及其预后优势仍不清楚。我们回顾了107例接受乐伐替尼治疗晚期HCC的连续患者的临床结局，并研究了包括手术在内的其他治疗的疗效。在107例最初不适合治疗性治疗或经动脉化疗栓塞（TACE）的患者中，54例（50.5%）在乐伐替尼治疗后接受了进一步治疗（手术[n = 16]和TACE或其他治疗[n = 38]）。在接受手术干预的16例患者中，9例（8.4%）患者实现了R 0切除。生存分析证实，成功转为R 0切除术与治疗失败时间延长相关（风险比[HR] 0.04，95%置信区间[CI] 0.01-0.29; p = 0.002）和更好的疾病特异性生存期（HR 0.04，95% CI 0.01-0.30; p = 0.002），而除手术或R2切除术外的其他治疗仅与边缘或无预后优势相关。多变量分析证实，血浆脱-γ-羧基凝血酶原水平较基线水平降低（比值比22.22，95% CI 3.42-144.29; p = 0.001）与乐伐替尼治疗后成功的R 0切除显著相关，与影像学分析评估的肿瘤缓解无关。在选定的晚期HCC患者中，只要实现R 0切除，乐伐替尼治疗后的转换手术可能提供显著的生存获益。
Background. With the introduction of new molecular-targeted agents, an increasing number of patients with advanced hepatocellular carcinoma (HCC) are benefiting from salvage interventions; however, the actual rate of conversion surgery and its prognostic advantages remain unclear.Methods. The clinical outcomes of 107 consecutive patients who underwent lenvatinib treatment for advanced HCC were reviewed and the efficacy of additional therapy, including surgery, was investigated.Results. Of the 107 patients who were initially unsuitable for curative-intent therapy or transarterial chemoembolization (TACE), 54 (50.5%) received further therapy after lenvatinib treatment (surgery [n = 16] and TACE or other treatments [n = 38]). Of the 16 patients who received surgical intervention, R0 resection was achieved in 9 (8.4%) patients. Survival analysis confirmed that successful conversion to R0 resection was associated with a longer time to treatment failure (hazard ratio [HR] 0.04, 95% confidence interval [CI] 0.01-0.29; p = 0.002) and better disease-specific survival (HR 0.04, 95% CI 0.01-0.30; p = 0.002) compared with no additional treatment, while additional treatment other than surgery or R2 resection was associated with only a marginal or no prognostic advantage. Multivariate analysis confirmed that a decrease in plasma des-gamma-carboxyprothrombin levels compared with baseline levels (odds ratio 22.22, 95% CI 3.42-144.29; p = 0.001) was significantly correlated with successful R0 resection after lenvatinib treatment, irrespective of the tumor response as assessed by imaging analysis.Conclusions. In selected patients with advanced HCC, conversion surgery after lenvatinib treatment may offer significant survival benefit as long as R0 resection is achieved.